File: /var/www/html/labs-case/index.php
<?php
require "functions.php";
?>
<html lang="en-US" class="js html-has-lrm">
<!-- <html xmlns="http://www.w3.org/1999/xhtml" lang="ah" xml:lang="ah"> -->
<head>
<meta charset="UTF-8">
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/css/bootstrap.min.css">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.4.1/jquery.min.js"></script>
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.7/js/bootstrap.min.js"></script>
<meta name="viewport" content="width=device-width, initial-scale=1.0, minimum-scale=1.0, maximum-scale=1.0, user-scalable=no">
<meta name="author" content="Praveen Singh Shekhawat - www.praveenshekhawat.com">
<script src="https://ajax.googleapis.com/ajax/libs/jquery/3.1.0/jquery.min.js"></script>
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css">
<link rel="stylesheet" href="https://labsinitiative.com/wp-content/themes/labsinitiative/css/main.css">
<link href='http://fonts.googleapis.com/css?family=Khmer' rel='stylesheet' type='text/css'>
<title>Web to Case | LABS Initiative</title>
<style>
.main_banner .menu {
background: #fff;
position: relative;
top: 0px;
left: 0;
right: 0;
z-index: 20000;
background: #fff;
border-bottom: 7px solid #f0522a;
box-shadow: 0px 0px 5px 1px #4c4c4c87;
}
</style>
</head>
<body class="home page-template page-template-template page-template-home-page page-template-templatehome-page-php page page-id-5 wp-embed-responsive group-blog responsive-menu-slide-left has-lrm" data-new-gr-c-s-check-loaded="14.1073.0" data-gr-ext-installed="">
<div class="se-pre-con" style="display: none;">
<div class="spinner"></div>
</div>
<div class="main_banner">
<div class="menu">
<div class="container">
<div class="col-sm-3 col-md-3">
<a href="https://labsinitiative.com/"><img src="https://labsinitiative.com/wp-content/themes/labsinitiative/images/logo.png" class="menu_logo"></a>
</div>
</div>
</div>
<div class="orange_line"></div>
</div>
</div>
<?php
$trans_form_data = form_data();
// echo "<pre>";
// print_r($trans_form_data);
// echo "</pre>";
?>
<br/><br/><br/><br/><br/><br/>
<div class="container">
<div class="row">
<div class="col-md-12">
<form action="" method="post" class="" novalidate="novalidate" data-status="init">
<div class="">
<h3><?php echo $trans_form_data['page_heading']; ?></h3>
<br/><br/>
<div class="row">
<div class="col-md-6">
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"><?php echo $trans_form_data['name']; ?></label>
<div class="col-sm-9">
<input type="text" name="user_name" value="" size="40" class="form-control" aria-required="true" aria-invalid="false" placeholder="Your Name">
</div>
</div>
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"><?php echo $trans_form_data['mobile_number']; ?></label>
<div class="col-sm-9">
<input type="text" name="mobile_number" value="" size="40" class="form-control" aria-required="true" aria-invalid="false" placeholder="mobile" value="">
</div>
</div>
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"><?php echo $trans_form_data['factory_name']; ?></label>
<div class="col-sm-9">
<input type="text" name="factory_name" value="" size="40" class="form-control" aria-required="true" aria-invalid="false" placeholder="Subject">
</div>
</div>
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"><?php echo $trans_form_data['country']; ?></label>
<div class="col-sm-9">
<input type="text" name="country" size="40" class="form-control" aria-required="true" aria-invalid="false" placeholder="country" value="<?php echo $trans_form_data['country_value']; ?>">
</div>
</div>
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"><?php echo $trans_form_data['state']; ?></label>
<div class="col-sm-9">
<?php
$state_data = state_data();
if(count($state_data) > 0){
?>
<select name="state_name" class="form-control">
<option value="">Select State</option>
<?php
foreach ($state_data as $key => $item)
{
?>
<option value="<?php echo $key; ?>"><?php echo $item; ?></option>
<?php
}
?>
</select>
<?php
}
?>
</div>
</div>
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"><?php echo $trans_form_data['city']; ?></label>
<div class="col-sm-9">
<?php
$city_data = city_data();
if(count($city_data) > 0){
?>
<select name="state_name" class="form-control">
<option value="">Select City</option>
<?php
foreach ($city_data as $key => $item)
{
?>
<option value="<?php echo $key; ?>"><?php echo $item; ?></option>
<?php
}
?>
</select>
<?php
}
?>
</div>
</div>
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"><?php echo $trans_form_data['factory_address']; ?></label>
<div class="col-sm-9">
<input type="text" name="factory_address" value="" size="40" class="form-control" aria-required="true" aria-invalid="false" placeholder="Factory address">
</div>
</div>
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"><?php echo $trans_form_data['position_at_factory']; ?></label>
<div class="col-sm-9">
<input type="text" name="position_at_factory" value="" size="40" class="form-control" aria-required="true" aria-invalid="false" placeholder="Position at factory">
</div>
</div>
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"><?php echo $trans_form_data['supervisor_name']; ?></label>
<div class="col-sm-9">
<input type="text" name="supervisor_name" value="" size="40" class="form-control" aria-required="true" aria-invalid="false" placeholder="Supervisor name">
</div>
</div>
</div>
<div class="col-md-6">
<div class="form-group row">
<label class="col-sm-4 col-form-label" for="user_name"><?php echo $trans_form_data['issue_you_are_facing']; ?></label>
<div class="col-sm-8">
<textarea name="issue_you_are_facing" cols="40" rows="10" class="form-control" aria-invalid="false" placeholder="Your Message"></textarea></div>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<div class="form-group row">
<label class="col-sm-3 col-form-label" for="user_name"></label>
<div class="col-sm-9">
<input type="submit" value="<?php echo $trans_form_data['submit_btn']; ?>" class="form-control" style="background:#ccc;">
<span class="ajax-loader"></span>
</div>
</div>
</div>
</div>
</div>
<div class="wpcf7-response-output" aria-hidden="true"></div>
</form>
</div>
</div>
</div>
</body>
</html>